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Cross-functional Teams under Total Quality Management: Enhancing
Unplanned Extubation Practices, Experience from County-level Hospital in China

C. Chen, G. Yu, and M. Li 2
2
1
Pain Medicine Department, Affiliated Hospital of Chengdu University, China, and Nursing Department,
1 2
Jiuzhaigou County Peoples’ Hospital, China

Background: Unplanned extubation (UEX) significantly impacts patient safety and healthcare costs,
particularly in resource-limited rural hospitals. Recognizing the need for better catheter management,
this study introduces a comprehensive quality improvement initiative based on Total Quality
Management (TQM) principles, supported by a Cross-Functional Team (CFT).

Objective: The aim of this study is to evaluate the effectiveness of a structured quality improvement
framework using TQM and CFT in reducing UEX rates in a rural hospital setting, thereby enhancing
nursing quality and patient outcomes.

Methods: This intervention was conducted at a county-level Hospital in southwest China over a
two-year period (2021-2022). A CFT comprising members from nursing, medical affairs, logistics,
and information technology departments was established to integrate multidisciplinary efforts. Key
interventions included standardizing catheter management protocols, intensive staff training, and
real-time quality control measures. Data on UEX rates before and after the implementation were
meticulously recorded and analyzed.

Results: Within two years after completing all improvement measures, no UEX incidents were
reported, achieving a complete reduction from the baseline rates. The initial rates were 1.285‰ for
tracheal catheters, 0.997‰ for nasogastric catheters, and 1.634‰ for urinary catheters.
Oral Presentation Abstracts
Conclusion: The outstanding success of this initiative demonstrating the effectiveness of TQM and
CFT, supports its broader application in rural healthcare systems. It underscores the adaptability and
significant impact of these frameworks in improving nursing care, patient safety, and outcomes in
resource-limited environments.

Keywords: rural healthcare, quality improvement, total quality management, cross-functional team

_____________________________________________________________________________________________________
Correspondence: GuoXia Yu, Nursing Department, Jiuzhaigou County Peoples’ Hospital, China
E-mail: yuguoxiajzg@163.com

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